Anniversary archives
Will the final battle not be between good and evil, but rather injuriologists and accidentologists? Danilo Blank,1 Huiyun Xiang2 Injury control (or injury prevention and safety promotion, as many prefer) is a very young scientific discipline. Many constructs and related terminologies in this field are still evolving, and often actually blurred. To settle a common working academic nomenclature within it has proved a formidable if not utopian undertaking, given both the broad array of professional disciplines involved and the fact that mostly all preventive actions entail a dynamic interplay with communities worldwide. Thus, many common language words have been unevenly terminologised, so that terms have become dubious and sometimes contentious within the injury field and beyond.1–5 As to the particular role of the word ‘accident’ within the injury field lexicon, we observed 50 years that separated us from Bill Haddon’s seminal works on what he called the phenomena of trauma. Dr Haddon urged those who would make scientific contributions in the injury field to avoid approaches which translated the traditional, prescientific wisdom into scientific terms and jargon.6 However, we have been witnessing a great deal of debate between those who sustain that the modern science of injury control can chase away the hodgepodge term, on the grounds of its alleged—albeit not based on empirical evidence—notions of randomness and unpreventability undermining both scientific clarity and preventive efforts, and those who argue that risk control ultimately depends on perceptions and attitudes of common people, and thus their conception of accident must always be taken into account. That is, an ongoing dispute between (if you may call them so) injuriologists and accidentologists. Eventually, the Haddonist hegemony over English-speaking academics, especially in the USA and Australasia, brought 1
Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; 2Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA Correspondence to Dr Danilo Blank, Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Rua Gen Jacinto Osorio 150/201, Porto Alegre, RS 90040-290, Brazil; [email protected]
about a near consensus, that the term ‘accident’ should not be used when referring to the so-called unintentional injury events.7 Indeed, at the time of the inception of the journal Injury Prevention 20 years ago, the prevailing attitude among authors within the injury field had been, for some years already, to focus heavily on injuries themselves and to eschew the word ‘accident’ altogether.8 9 However, it was noteworthy that both the very first editorial and one of the introductory opinion articles casted doubts on the appropriateness of the banishment of the word ‘accident’ from the injury researcher’s vocabulary,10 or at least conceded that practical difficulties and conceptual problems might arise from conflating injury events and their outcomes.11 Deborah Girasek’s article, published in Injury Prevention in March 1999, was the first methodologically sound search for empirical evidence supporting injury prevention professionals’ assertion that laypeople embraced prescientific concepts of injury causation, thus associating the word accident with ideas of non-preventability and fatalism. Yet, results of this important study showed that the only concept that laypeople associated very strongly with the word ‘accident’ was that of unintentionality. It was found that 83% of the subjects stated that when they heard the word ‘accident’ they usually thought that what had happened could have been prevented.12 The merit of this study was highlighted at first by the fact that it shattered the long-held conviction of the editor of Injury Prevention, Barry Pless, that the use of the word ‘accident’ was harmful to preventive efforts. In fact, Pless actually stated that, like most injury prevention zealots (sic), he had been convinced that the term ‘accident’ usually conveyed the idea that the injury was not preventable, but, even still believing that the word should be better avoided. The editor had been impressed with the rigour of the work and had had no hesitation agreeing it should be published.13 Girasek’s work was important because it marked the swinging back of the pendulum Blank D, et al. Inj Prev June 2015 Vol 21 No 3
from the zeitgeist of post-Haddon days up to the turn of the century—when the complexities of human–environment interchanges that led to injury events seemed to be gathering less attention than the misfortunate outcomes—to a time of more broad-minded considerations, which allowed the creation of new conceptual and theoretical frameworks comprising all dimensions of the injury phenomenon.14 15 Notwithstanding, in the course of events, Ron Davis and Barry Pless penned a BMJ editorial entitled “BMJ bans ‘accidents’—accidents are not unpredictable”, in which they announced that from then on all BMJ publications would avoid the use of the word accident. In response to a flood of criticisms, they distilled the negative commentaries into 10 key arguments and replied to each one of them in a text that turned out to be probably the most sensible and authoritative statement ever on why to avoid using the word ‘accident’ in scientific discourse. Among their main arguments: people can be taught to foresee injury events; beyond the matter of preventability and predictability, ‘accident’ is much too imprecise as a term since it refers to a number of diverging concepts, covering everything from spilled milk to death; it is quite feasible to use alternative terms (such as fall, collision or drowning), but, whenever the clumsiness quotient of replacement is too high, then the word ‘accident’ should be perfectly allowed.16 17 Anyway, with Girasek’s paper came more rigorous studies on injury terminology that gradually set the stage for the following conception: Yes, in general language, accidents are random—meaning that the time of occurrence cannot be predicted with certainty, not that the events are independent of risk, that is, unforeseeable—and unforeseen, and yet preventable—meaning that the causes are identifiable and/or worth investigating events. The lay notions of the word ‘accident’ seem to carry more subtleties than those who advocate for simply banning it from the academic lexicon maintain. In lack of a better academic term for such concept, perhaps it is time that injury preventionists reconsider the role that the word ‘accident’, now properly terminologised, might have in injury epidemiology, as long as it never takes precedence to more specific terms. Above all, it should never be applied to mean the ensuing injury itself.1 18–20 As journals like Injury Prevention increasingly aim at international readership, researchers should also gaze at the evidence that terminological imprecision and ambiguity seem to be even more pronounced in settings that are outside the 211
Anniversary archives realm of the English-language literature.21–26 Could it be that the final battle will not be between good and evil, but rather injuriologists and accidentologists? Contributors DB and HX wrote a joint commentary and made the bibliographic review.
4
5
Competing interests None. Provenance and peer review Commissioned; internally peer reviewed.
6
7
To cite Blank D, Xiang H. Inj Prev 2015;21:211–212. Received 9 November 2014 Accepted 13 November 2014
8
Inj Prev 2015;21:211–212. doi:10.1136/injuryprev-2014-041482
9
REFERENCES 1
2
3
Wentz R, Roberts I, Bunn F, et al. Identifying controlled evaluation studies of road safety interventions—Searching for needles in a haystack. J Safety Res 2001;32:267–6. Banque de Données Santé Publique. Glossaire multilingue [Internet]. Rennes, France; 2003. http:// www.bdsp.ehesp.fr/Glossaire/ (accessed 02/11/ 2014). ICECI Coordination and Maintenance Group. International classification of external causes of injuries—version 1.2. Adelaide: Consumer Safety
10 11
12 13 14 15
Institute, Amsterdam and AIHW National Injury Surveillance Unit, 2004. Pless IB, Hagel BE. Injury prevention: a glossary of terms. J Epidemiol Community Health 2005;59:182–5. Lawrence DW. Using online databases to find peer-reviewed journal articles on injury prevention and safety promotion research: a study of textword queries by SafetyLit users. Inj Prev 2007;13:232–6. Haddon Jr W. The changing approach to the epidemiology, prevention, and amelioration of trauma: the transition to approaches etiologically rather than descriptively based. Am J Public Health 1968;58:1431–8. Langley JD. The need to discontinue the use of the term “accident” when referring to unintentional injury events. Accid Anal Prev 1988;20:1–8. Greensher J. Prevention of Childhood Injuries. Pediatrics 1984;74:970–5. Loimer H, Guarnieri M. Accidents and acts of God: a history of the terms. Am J Public Health 1996;86:101–7. Pless IB. Logo and logic. Inj Prev 1995;1:1–2. Bijur P. What’s in a name? Comments on the use of the terms ‘accident’ and ‘injury’. Inj Prev 1995;1:9–11. Girasek D. How members of the public interpret the word accident. Inj Prev 1999;5:19–25. Pless IB. Testing the editor. Inj Prev 1999;5:2-a-. Rivara FP. Prevention of injuries to children and adolescents. Inj Prev 2002;8(Suppl 4):IV5–8. Andersson R. The role of accident theory in injury prevention—time for the pendulum to swing back. Int J Inj Control Saf Promot 2012;19:209–12.
16 17
18 19
20
21
22
23
24
25
26
Davis RM, Pless B. BMJ bans “accidents”. Br Med J 2001;322:1320–1. Green JM, McConnell J, Ozanne-Smith J, et al. Rapid responses from BMJ.com. Br Med J 2003;327:53–5. Evans S. Banning the “A word”: where’s the evidence? Inj Prev 2001;7:172–5. Stone D. Ten myths about injury prevention that hinder effective child safety policy making. J R Soc Prom Health 2007;1127:161–3. Smith KC, Girasek DC, Baker SP, et al. ‘It was a freak accident’: an analysis of the labelling of injury events in the US press. Inj Prev 2012;18:38–43. Dixey RA. ‘Fatalism’, accident causation and prevention: issues for health promotion from an exploratory study in a Yoruba town, Nigeria. Health Educ Res 1999;14:197–208. Neira J, Bosque L. The word “accident”: No choice, no error, no destiny. Prehospital Disaster Med 2004;19:188–9. Ustun BT, Jakob R. Calling a spade a spade: meaningful definitions of health conditions. Bull World Health Organ 2005;83:802–3. Fraade-Blanar L, Concha-Eastman A, Baker T. Injury in the Americas: the relative burden and challenge. Rev Panam Salud Publica 2007;22:254–9. Blank D, Hohgraefe Neto G, Grando E, et al. A Web-based survey on students’ conceptions of ‘accident’. Inform Health Soc Care 2009;34: 189–208. Tan A, Zhang X, Baker SP, et al. How do public health practitioners in China perceive injury prevention? A survey. Inj Prev 2014;20:196–9.
Ollie Otter: children ‘otter’ buckle up In Mississippi, the law requires children aged 4–7 to be in booster seats if they are shorter than 4 feet 9 inches tall or weigh
Will the final battle not be between good and evil, but rather injuriologists and accidentologists? Danilo Blank,1 Huiyun Xiang2 Injury control (or injury prevention and safety promotion, as many prefer) is a very young scientific discipline. Many constructs and related terminologies in this field are still evolving, and often actually blurred. To settle a common working academic nomenclature within it has proved a formidable if not utopian undertaking, given both the broad array of professional disciplines involved and the fact that mostly all preventive actions entail a dynamic interplay with communities worldwide. Thus, many common language words have been unevenly terminologised, so that terms have become dubious and sometimes contentious within the injury field and beyond.1–5 As to the particular role of the word ‘accident’ within the injury field lexicon, we observed 50 years that separated us from Bill Haddon’s seminal works on what he called the phenomena of trauma. Dr Haddon urged those who would make scientific contributions in the injury field to avoid approaches which translated the traditional, prescientific wisdom into scientific terms and jargon.6 However, we have been witnessing a great deal of debate between those who sustain that the modern science of injury control can chase away the hodgepodge term, on the grounds of its alleged—albeit not based on empirical evidence—notions of randomness and unpreventability undermining both scientific clarity and preventive efforts, and those who argue that risk control ultimately depends on perceptions and attitudes of common people, and thus their conception of accident must always be taken into account. That is, an ongoing dispute between (if you may call them so) injuriologists and accidentologists. Eventually, the Haddonist hegemony over English-speaking academics, especially in the USA and Australasia, brought 1
Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; 2Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA Correspondence to Dr Danilo Blank, Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Rua Gen Jacinto Osorio 150/201, Porto Alegre, RS 90040-290, Brazil; [email protected]
about a near consensus, that the term ‘accident’ should not be used when referring to the so-called unintentional injury events.7 Indeed, at the time of the inception of the journal Injury Prevention 20 years ago, the prevailing attitude among authors within the injury field had been, for some years already, to focus heavily on injuries themselves and to eschew the word ‘accident’ altogether.8 9 However, it was noteworthy that both the very first editorial and one of the introductory opinion articles casted doubts on the appropriateness of the banishment of the word ‘accident’ from the injury researcher’s vocabulary,10 or at least conceded that practical difficulties and conceptual problems might arise from conflating injury events and their outcomes.11 Deborah Girasek’s article, published in Injury Prevention in March 1999, was the first methodologically sound search for empirical evidence supporting injury prevention professionals’ assertion that laypeople embraced prescientific concepts of injury causation, thus associating the word accident with ideas of non-preventability and fatalism. Yet, results of this important study showed that the only concept that laypeople associated very strongly with the word ‘accident’ was that of unintentionality. It was found that 83% of the subjects stated that when they heard the word ‘accident’ they usually thought that what had happened could have been prevented.12 The merit of this study was highlighted at first by the fact that it shattered the long-held conviction of the editor of Injury Prevention, Barry Pless, that the use of the word ‘accident’ was harmful to preventive efforts. In fact, Pless actually stated that, like most injury prevention zealots (sic), he had been convinced that the term ‘accident’ usually conveyed the idea that the injury was not preventable, but, even still believing that the word should be better avoided. The editor had been impressed with the rigour of the work and had had no hesitation agreeing it should be published.13 Girasek’s work was important because it marked the swinging back of the pendulum Blank D, et al. Inj Prev June 2015 Vol 21 No 3
from the zeitgeist of post-Haddon days up to the turn of the century—when the complexities of human–environment interchanges that led to injury events seemed to be gathering less attention than the misfortunate outcomes—to a time of more broad-minded considerations, which allowed the creation of new conceptual and theoretical frameworks comprising all dimensions of the injury phenomenon.14 15 Notwithstanding, in the course of events, Ron Davis and Barry Pless penned a BMJ editorial entitled “BMJ bans ‘accidents’—accidents are not unpredictable”, in which they announced that from then on all BMJ publications would avoid the use of the word accident. In response to a flood of criticisms, they distilled the negative commentaries into 10 key arguments and replied to each one of them in a text that turned out to be probably the most sensible and authoritative statement ever on why to avoid using the word ‘accident’ in scientific discourse. Among their main arguments: people can be taught to foresee injury events; beyond the matter of preventability and predictability, ‘accident’ is much too imprecise as a term since it refers to a number of diverging concepts, covering everything from spilled milk to death; it is quite feasible to use alternative terms (such as fall, collision or drowning), but, whenever the clumsiness quotient of replacement is too high, then the word ‘accident’ should be perfectly allowed.16 17 Anyway, with Girasek’s paper came more rigorous studies on injury terminology that gradually set the stage for the following conception: Yes, in general language, accidents are random—meaning that the time of occurrence cannot be predicted with certainty, not that the events are independent of risk, that is, unforeseeable—and unforeseen, and yet preventable—meaning that the causes are identifiable and/or worth investigating events. The lay notions of the word ‘accident’ seem to carry more subtleties than those who advocate for simply banning it from the academic lexicon maintain. In lack of a better academic term for such concept, perhaps it is time that injury preventionists reconsider the role that the word ‘accident’, now properly terminologised, might have in injury epidemiology, as long as it never takes precedence to more specific terms. Above all, it should never be applied to mean the ensuing injury itself.1 18–20 As journals like Injury Prevention increasingly aim at international readership, researchers should also gaze at the evidence that terminological imprecision and ambiguity seem to be even more pronounced in settings that are outside the 211
Anniversary archives realm of the English-language literature.21–26 Could it be that the final battle will not be between good and evil, but rather injuriologists and accidentologists? Contributors DB and HX wrote a joint commentary and made the bibliographic review.
4
5
Competing interests None. Provenance and peer review Commissioned; internally peer reviewed.
6
7
To cite Blank D, Xiang H. Inj Prev 2015;21:211–212. Received 9 November 2014 Accepted 13 November 2014
8
Inj Prev 2015;21:211–212. doi:10.1136/injuryprev-2014-041482
9
REFERENCES 1
2
3
Wentz R, Roberts I, Bunn F, et al. Identifying controlled evaluation studies of road safety interventions—Searching for needles in a haystack. J Safety Res 2001;32:267–6. Banque de Données Santé Publique. Glossaire multilingue [Internet]. Rennes, France; 2003. http:// www.bdsp.ehesp.fr/Glossaire/ (accessed 02/11/ 2014). ICECI Coordination and Maintenance Group. International classification of external causes of injuries—version 1.2. Adelaide: Consumer Safety
10 11
12 13 14 15
Institute, Amsterdam and AIHW National Injury Surveillance Unit, 2004. Pless IB, Hagel BE. Injury prevention: a glossary of terms. J Epidemiol Community Health 2005;59:182–5. Lawrence DW. Using online databases to find peer-reviewed journal articles on injury prevention and safety promotion research: a study of textword queries by SafetyLit users. Inj Prev 2007;13:232–6. Haddon Jr W. The changing approach to the epidemiology, prevention, and amelioration of trauma: the transition to approaches etiologically rather than descriptively based. Am J Public Health 1968;58:1431–8. Langley JD. The need to discontinue the use of the term “accident” when referring to unintentional injury events. Accid Anal Prev 1988;20:1–8. Greensher J. Prevention of Childhood Injuries. Pediatrics 1984;74:970–5. Loimer H, Guarnieri M. Accidents and acts of God: a history of the terms. Am J Public Health 1996;86:101–7. Pless IB. Logo and logic. Inj Prev 1995;1:1–2. Bijur P. What’s in a name? Comments on the use of the terms ‘accident’ and ‘injury’. Inj Prev 1995;1:9–11. Girasek D. How members of the public interpret the word accident. Inj Prev 1999;5:19–25. Pless IB. Testing the editor. Inj Prev 1999;5:2-a-. Rivara FP. Prevention of injuries to children and adolescents. Inj Prev 2002;8(Suppl 4):IV5–8. Andersson R. The role of accident theory in injury prevention—time for the pendulum to swing back. Int J Inj Control Saf Promot 2012;19:209–12.
16 17
18 19
20
21
22
23
24
25
26
Davis RM, Pless B. BMJ bans “accidents”. Br Med J 2001;322:1320–1. Green JM, McConnell J, Ozanne-Smith J, et al. Rapid responses from BMJ.com. Br Med J 2003;327:53–5. Evans S. Banning the “A word”: where’s the evidence? Inj Prev 2001;7:172–5. Stone D. Ten myths about injury prevention that hinder effective child safety policy making. J R Soc Prom Health 2007;1127:161–3. Smith KC, Girasek DC, Baker SP, et al. ‘It was a freak accident’: an analysis of the labelling of injury events in the US press. Inj Prev 2012;18:38–43. Dixey RA. ‘Fatalism’, accident causation and prevention: issues for health promotion from an exploratory study in a Yoruba town, Nigeria. Health Educ Res 1999;14:197–208. Neira J, Bosque L. The word “accident”: No choice, no error, no destiny. Prehospital Disaster Med 2004;19:188–9. Ustun BT, Jakob R. Calling a spade a spade: meaningful definitions of health conditions. Bull World Health Organ 2005;83:802–3. Fraade-Blanar L, Concha-Eastman A, Baker T. Injury in the Americas: the relative burden and challenge. Rev Panam Salud Publica 2007;22:254–9. Blank D, Hohgraefe Neto G, Grando E, et al. A Web-based survey on students’ conceptions of ‘accident’. Inform Health Soc Care 2009;34: 189–208. Tan A, Zhang X, Baker SP, et al. How do public health practitioners in China perceive injury prevention? A survey. Inj Prev 2014;20:196–9.
Ollie Otter: children ‘otter’ buckle up In Mississippi, the law requires children aged 4–7 to be in booster seats if they are shorter than 4 feet 9 inches tall or weigh
![[Good tasting is half the battle: it could all be so simple, but it's not].](/assets/img/hold.png)
